Florida RN mentors nurses in Afghanistan

Capt. Debora Beltzer-Harper, left, medical plans, forward surgeon and nurse-educator for the 1st Theater Sustainment Command, and U.S. Air Force Capt. James Thompson, a native of Snohomish, Wash., and physician for U.S. Forces-Afghanistan, stand beside their Afghan medical counterparts at the bedside of a severely wounded Afghan soldier, during one of the nurse mentoring visits in Afghanistan.

After her workday of overseeing the health and welfare of a brigade of soldiers in Afghanistan, U.S. Army Capt. Debora Beltzer-Harper RN, MBA, BHS, MSN, grabs her stethoscope and heads to a 12-floor hospital in Kabul for another engagement: as a volunteer mentor teaching Afghani nurses.

It’s a bit of a change from her role as director of nursing education at Armor Correctional Health Services in West Palm Beach, Fla., a position she temporarily left when she was deployed to Afghanistan as an Army reservist in August 2013.

“The majority of Afghan nurses are males due to the culture,” she explained, and have a basic knowledge of nursing. “I reviewed some of the courses they’ve had and they’re pretty well rounded.” However, once on the hospital floor, she said these nurses don’t have the benefit of mentors or preceptors, nor do they seem to have team leaders.

On her first day in the Afghani ICU, Beltzer-Harper observed how the nurses handled patient care. “I asked them basic questions — how often do you bathe the patients, how often do you turn them? Do you do oral care?” These observations guidedher teaching.

At the Afghan Army hospital Jan. 20 in Kabul, Afghanistan, Capt. Debora Beltzer-Harper demonstrates to a combined female and male Afghan intensive care unit and ancillary nursing staff how to properly auscultate the lungs during physical assessment.(Photos courtesy of U.S. Army)

Volunteer opportunity knocks

Her unique volunteer opportunity arose from a casual conversation with Army doctors working with Afghan hospitals. “They told me about a program started about 10 years ago by the Canadian military to advise nurses,” she said. “But since the [Canadian] mission had ended, they didn’t have a nurse to help.”

After observing the Afghani nurses and building relationships with their director of nursing, Beltzer-Harper found herself working through a Dari language interpreter to demonstrate mechanical suction, essential elements of infection control and use of oxygen.

Old equipment — vintage 1970s — is common, she said. High-tech machinery or wall-mounted suction is non-existent; the oxygen unit sits next to the bed. Even stethoscopes are scarce so Beltzer-Harper hopes to acquire more.

Focus on efforts making a difference

Over her six visits with Afghani nurses to date, she looks at practical elements of nursing care where her contributions can make a difference. “The nurses are very open and ask lots of questions,” she said. “The fact that I’m volunteering has made it easier; they know I don’t have to be there.”

Beltzer-Harper carefully refrains from appearing as a foreigner with superior knowledge. Instead, she engages from a collegial mindset. “I explain that [in the U.S.] we have to take certain classes every year as a refresher, not because we don’t know the information. I explain it’s important to keep learning.”

Using creativity, Beltzer-Harper has wielded her iPhone to play audio files of lung sounds while discussing lung auscultation with the staff. She hopes her PowerPoint lectures, translated into Dari, will provide continued training for seasoned and new nursing staff after her deployment ends inMay 2014.

Until then, Beltzer-Harper hopes to focus on charting, which is solely paper-based, to encourage the nurses to document their nursing assessments. Occasionally the culture gets in the way of her teaching. “I was talking about cloudy urine related to Foley care, and they didn’t understand. ‘Cloudy’ isn’t a word that translated to Dari so I just had to say, ‘Write clear. If it’s not clear, then write it down,’” she said.

Cultural differences

And she confronts cultural contrasts with grace. “It makes me crazy that some [Afghani] nurses wear sandals with no socks! I’ve had to let some things go. I just mentioned that clogs with socks would work better.”

Family's military history

Beltzer-Harper is from a family with a long line of military members who can trace their family’s military service back to the Civil War, Beltzer-Harper said.

She grew up in the military — her father was in the U.S. Air Force. All but one of her five siblings is in the military. Beltzer-Harper joined the Army in 1976, just out of high school. Then seven years ago, she joined the Army Reserve.